PN1130 Communication and Therapeutic Relationships Notes PDF

PN1130 Communication and Therapeutic Relationships Objective 1 This Photo by Unknown Author is licensed under CC B 1 Why do I Need to Complete a Communication Course ? -We will examine how to interact or respond in a variety of situations. I communicate with people all the time…..class, phone ,...

PN1130 Communication and Therapeutic Relationships Objective 1 This Photo by Unknown Author is licensed under CC B 1 Why do I Need to Complete a Communication Course ? -We will examine how to interact or respond in a variety of situations. I communicate with people all the time…..class, phone , text, email…. -How might you engage a faculty member to discuss a grade you have received? -How would you communicate with a patient in order to obtain relevant information? -How do you collaborate with other LPNs, RNs, doctors, other health care professionals? -What about documenting? 2 Communication and Therapeutic Relationships What are some words that come to your mind when you think of nursing? Job, empathy, caring, 3 Caring  “an intentional human action characterized by commitment and a sufficient level of knowledge and skill to allow nurses to support the basic integrity of the person” (Mallette & Yonge, 2022, p. 552 -So caring when it comes to nursing is more than just being kind -Note the highlighted areas -We look at caring in a professional way 4 What Does Professional Caring Involve? www.washingtonpost.com Knowledge www.picpedia.org Compassion www.washingtonpost.com Empathy www.alleywatch.com Safety www.ruthvens.com Can you think of others? Next slide will entail all but see if students can come up with others on their own first. 5 Professional caring involves         Essential to nursing Complex relationship Knowledge Being present Compassion Empathy Giving of self Effective  Safe  Client focused  Timely  Equal  Efficient  Actions that are focused on positive outcomes Nursing is the caring profession More than just being sweet and kind Part of the job, part of the profession Client focused – not about student, although will effect the student. Keep in mind it’s about the client 6 Foundational Concepts of Nursing  Caring for clients is a core value of nursing.  Learning and developing communication techniques and skills.  The development and establishment of therapeutic relationships in nursing. -Prior to getting into the four objectives, look at these foundational concepts of nursing -N103 introduces the learner to foundational communication skills, how to set up a nurse – client therapeutic relationship, and what caring means in nursing. -Why communication is important & how it is essential to the development of TR. -We focus on how communicating is about connecting with a person for a therapeutic purpose, in your role of nurse This course is about: promoting understanding between the nurse and patient Advancing physical and emotional well-being of patients Provide support and information to patients Providing you with the knowledge, skills, tips and insights into how you communicate with others and build therapeutic relationships 7 Therapeutic Relationships ___________________________________ Objective 1: Discuss the significance of communication and therapeutic relationships in nursing practice Chapter 1, 2, 3 (p.47), 11 & 12 8 Objective 1  Define communication  Define therapeutic relationships  Discuss the importance  Identify the and therapeutic communication of communication in healthcare metaparadigm concepts of nursing 9 Communication  Communication: Verbal and non-verbal behaviours combined to share information that is timely, accurate, complete, unambiguous, and understood by the patient (Mallette & Yonge, 2022)  The exchange of information, thoughts and feelings among people using speech or other means Connects people and ideas through words, nonverbal behaviours, and actions A key means to share information, ask questions, and seek assistance In your nursing education, you will have numerous opportunities to communicate with other nursing students, faculty, clients, families, nurses, other health care professionals You will educate, gather data or information, explain skills and procedures, collaborate, complete assignments You will encounter clients that are willing to communicate, have challenges with communication. This is why it is important to learn to communicate therapeutically . 10 Communication There are different levels of communication. Verbal vs. non-verbal communication Communication can occur on several levels: • Intrapersonal level – own thinking; self talk • Interpersonal level – one to one • Transpersonal level – spiritual level • Small group – small numbers of people with common purpose • Public communications – interact with an audience Research shows that when we communicate feelings and attitudes, only a small percentage of our overall message comes from the words we use. 55% of our message comes from body language (especially from movements of the small muscles of the eye which can convey shock, disbelief, doubt or disgust); 38% of our message comes from tone or voice. Only 7% of our message is conveyed by the words we use. For example: in a health care setting, you can have someone denying they have pain, however you can see facial grimacing. We all need to have insight into our communication style in order to communicate effectively: 1) Body language, words, tone of voice, eyes, writing 2) Eye contact/Validate/engage 3) Validate what has been said, reassure, paraphrase 11 Therapeutic Communication  A goal directed form of communication used in health care to achieve goals that promote health and well–being. (Mallette & Yonge, 2022) It’s a two-way process between the patient and nurse that requires an understanding of the patient and the experiences they express. A goal directed form of communication used in health care to achieve goals that promote health and well–being. It focuses on advancing the physical and emotional well-being of patients. Nurses use therapeutic communication techniques to provide support and information to patients. This skill is critical for nurses. It occurs in a variety of ways: through words, facial expressions, body language, digitally, through documentation and through behaviours. Therapeutic communication may not appear to require extra study, however in therapeutic conversations health care providers must ensure mindfulness allowing them to consider each person’s unique situation while simultaneously monitoring their own responses and reactions. 12 What is a Therapeutic Relationship? An alliance whereby the nurse and client meet for a period to achieve health related treatment goals. ( Mallette & Yonge, 2022) Define therapeutic relationships A therapeutic communication is one event; the therapeutic relationship is a partnership that develops over a certain period of time with the use of therapeutic communication. It is different from social relationships in multiple key ways. The therapeutic nurse-client relationship is the fundamental means for providing safe, competent, compassionate, and ethical nursing care. Nursing practice, implemented through the therapeutic nurse-client relationship, is theoryguided and evidence-based (Mallette & Yonge, 2022). There are defined phases of a therapeutic relationship. Pre-interaction Phase; Orientation Phase; Working Phase; Termination Phase Hildegarde Peplau (1997) These will be covered in more detail in Objective 4 13 It is this component of professional relationships that is best remembered by people, families, and nurses Communication is as important as the care itself. 14 Why is Communication Important in Healthcare?  Impacts the delivery of care  Leads to better health outcomes  Enhanced patient understanding of their health condition  Greater patient satisfaction  Decreased health care costs  Reduced length of hospital stay  Greater job satisfaction  Safety Impacts the delivery of care-Communication between healthcare providers and the people being cared for impacts the way care is delivered; it is as important as the care itself. People are more likely to understand their health conditions through meaningful communication and to alert providers when something feels wrong. Leads to better health outcomes- as it can lead to a more effective diagnosis, a better understanding of the patients health condition and earlier recognition of health changes. Patients are more likely to inform providers/ ask questions when there is good communication Greater patient satisfaction- communication failures can also cause more intense caregiver dissatisfaction, and rapid staff turnover Decreased health care costs & reduced length of hospital stay Patients are more likely to inform providers/ ask questions when there is good communication Greater job satisfaction- More: partnership between patient and nurse and knowing the patient more than just the senior in bed 2 room 218 Safety– which we will discuss further 15 Safety  Defined by the Canadian Patient Safety Institute [CPSI] (2020a) as “the pursuit of the reduction and mitigation of unsafe acts within the health care system, as well as the use of best practices shown to lead to optimal patient outcomes”. Communication is an important aspect of patient safety for example: between healthcare providers, research has shown that ineffective team communication is the root cause for approx. 66% of all errors. Can you think of an example of this? - Accurate/effective communication translates to increased safety and better patient outcomes. 16 Communication Considerations for Patient Safety Miscommunication System Problem Errors Multiple studies have pinpointed miscommunication as a major cause of errors resulting in unnecessary death and serious injury. Example on page 20 in your textbook- student communicating to staff nurse she will be giving medications for the shift, however she is only to give oral medications which may cause patient to miss IV medications for 8 hours which could lead to serious consequences. System problem errors- can be because of confused orders, poor communication of expectations, or a failure to communicate potential risks, such as allergies to medications, infection control or fall risk. --using a standardized tool to such as a hand off sheet to ensure comprehensive and safer hand offs. 17 Barriers to Safe and Effective Communication Fragmentation  Hand-offs (transfers)  Underreporting of errors Fatigue  Long shifts, with little rest or nutrition Fragmentation- gaps in communication and poor communication which continues to be the single largest contributor to patient harm. It is very important for communication to be clear, concise, accurate and timely. Hand-offs or transfers of patient care involve transferring of information and responsibility of care from one nurse to the next. Often during this transfer there can be miscommunication errors and this is why it is important to teach you how to properly hand over report. Underreporting of errors- many nurses will not report near misses or errors (even if they are not at fault) for fear of repercussions. It is important to report all errors and near misses to promote safety. It is important to recognize that human error occurs and everyone's focus needs to be on correcting system flaws to avoid future adverse events, rather than finding out who is to blame. Fatigue- errors are more likely to occur during long shifts, with little rest or nutrition. The risk nearly doubles when nurses work more than 12 consecutive hours. Nurses needs to take responsibility to be aware of and recognize signs and symptoms of fatigue and identify strategies to mitigate and manage their fatigue and self care. ---example stayed late but set my limits. Self care- ensuring you have coping mechanisms to assist yourself in stressful situations, this is something asked now in a lot of nursing interviews. Employers recognize this as an important attribute of a nurse. 18 Tools for Safer Care  Clinical situation simulations  Use of standardized -Checklists communication tools  Use of SBAR  Crew Resource Management (CRM)-Based Tools Clinical situation simulations which develop and refine clinical situation simulations. Students learn in a safe low-stakes simulation lab. The simulation allows for practice without the risk of potentially bad outcomes in an actual patient care situation. Use of standardized communication tools such as checklists, which have been found to reduce medical errors and adverse events, leading to improved patient safety and positive outcomes. Following a checklist ensures that key steps will not be missed and important information is communicated and not missed due to fatigue, pressure or distraction. Use of SBAR- which I will discuss more on the next slide Crew Resource Management (CRM)-Based tools- a tool similar to SBAR- provides rules of conduct for communication, especially during hand off care transitions. With this tool the healthcare providers stop and summarize what is happening and each member of the team can communicate safety concerns 19 SBAR  S-Situation  B-Background  A-Assessment  R-Recommendation Table 2.2 on Page 27 S- Situation- identify yourself, the patient and the problem. State what is going on. B-Background- state relevant context and brief history- important to review the chart if possible before speaking to the physician- include the patients background such as diagnosis, allergies, vital signs, medications that have been administered, and laboratory results A- Assessment- state your assessment or conclusion, what you think is wrong. List your opinions about the patient's current status. R- Recommendation or request- state your informed suggestion for the continued care of this patient. Propose an action. 20 What is a Metaparadigm?  A general statement about a group of ideas that form the foundation of a discipline  For example, it helps define “What is nursing?”  It distinguishes Nursing from other disciplines Objective 1.4 - Identify the metaparadigm concepts of nursing Another word for ideas is “constructs” 21 The Metaparadigm for Nursing Four core constructs which comprise the nursing metaparadigm:  Person  Environment  Health  Nursing https://nurseslabs.com/nursing-theories/ Nursing metaparadigm distinguishes the nursing profession from other disciplines & emphasizes its unique function characterized by 4 key major concepts that are interrelated & fundamental to nursing theory: person, environment, health, and nursing. These are collectively referred to as metaparadigm for nursing. Person: (Client ) is the recipient of nursing care & may include individuals, clients , groups, families, & communities.; culture Environment: (situation) : the internal & external surroundings that affect the client; includes +/- conditions that affect the client, physical environment, (families, friends, & significant others, & HC setting ; determinants of health Health: the degree of wellness or well-being that the client experiences. Different meanings for every client, the clinical setting, & HCP. Health – state of complete physical, mental and social well-being, not merely the absence of disease or infirmatity” Nursing: The attributes, characteristics, & actions of the nurse providing care on behalf /with the client. Numerous definitions of nursing; nursing scholars may disagree on the exact definition, but the ultimate goal of nursing theories is: The goal of nursing is to provide & improve client care. So how do nurses provide care? – then next slide 22 Person  Person is defined as the recipient of nursing care  Refers to individuals, families, and communities Knowledge of the person is the start of developing a therapeutic relationship and the delivery of nursing care. Person: (Client ) is the recipient of nursing care & may include individuals, clients , groups, families, & communities.; culture- this is recognition that nurses provide holistic care not only at the individual level, but also to families, groups and communities. For example: infants, older adults, children, etc. Nurses have a responsibility to protect each human being’s integrity, well-being, and right to self-determination in obtaining care ( Mallette & Yonge, 2022). 23 Environment  The context in which place (WHO, 2001). health relationships take  External and internal factors that support or impede health and well-being  Includes conditions that affect the client The context in which health relationships take place (WHO, 2001). External and internal factors that support or impede health and well-being Includes conditions that affect the client –socioenvironmental factors- at the community level poverty, education, religious and spiritual beliefs, type of community (rural or urban), family strengths or challenges, level of social support, health resource availability and ease of accessing care. 24 Health  Derived from the word whole  A term that can be interpreted differently Derived from the word whole A term that can be interpreted differently by things such as, culture, religious beliefs and previous life experiences can influence how someone perceives health. For example: in some cultures where poverty is a significant factor, having a robust body size is considered a sign of a healthy lifestyle. While in a different culture , a similar body size would be considered a sign of an unhealthy lifestyle 25 Nursing  Attributes, characteristics and actions of the nurse providing care on behalf/with the client  The goal of nursing is to provide and improve client care Nursing: The attributes, characteristics, & actions of the nurse providing care on behalf /with the client. Numerous definitions of nursing; nursing scholars may disagree on the exact definition, but the ultimate goal of nursing theories is: The goal of nursing is to provide & improve client care. So how do nurses provide care? – then next slide 26 Nurses provide care by using the Nursing Process 27 Nursing Process 5 Progressive Stages (Table 3.3)  Assessment  Problem Identification and Diagnosis  Outcome Identification and Planning  Implementation  Evaluation Central to client care, it is a means of planning and directing client care to achieve health goals /outcomes. Discussed further in. Intro to Nursing course Table 3.3 Malette and Yonge text 28 Table 3.2 Communication in the nursing process, communication standards and skills are an integral component of the knowledge, experience, skills and attitudes encompassed in using the nursing process to deliver care. 29 The Art and Science of Nursing The Art of Nursing- Is the caring The Science of Nursing- Is the knowledge The art of nursing- nursing is also grounded in human interactions and relationships. Understanding the nature of health/needs through a patients perspective through caring, compassion and therapeutic communication The science of nursing= theory, evidence informed practice, research, clinical guidelines, etc. 30 Patterns of Knowing  Empirical  Personal  Aesthetic  Ethical  Emancipatory Empirical- incorporating logical reasoning and problem solving Personal- personal self awareness to be able to know oneself and being able to engage and relate to others. Self-awareness assists in a nurse to self-check any biases that may prevent authentic connections. As well to be able to show empathy towards an individuals’ condition. Aesthetic- a deeper appreciation of the whole person or situation, moving past the superficial. Allowing the nurse to relate to the emotions of your patients and understand the person as a whole, while making use of scientifically supported interentions. Ethical- when nurses confront the moral aspects of nursing care and using ethical principles and professional standards of conduct to guide nursing care. – what is right vs. wrong with attention to professional standards. Emancipatory- awareness of social problems and social justice issues as they contribute to the determinants of health. With improved knowledge of social, political, and economic determinants of health and well-being , nurses can serve as better advocates in assisting people, families and communities collectively, to identify and reduce inequities in health care. 31 Summary Caring is fundamental in nursing Good communication is necessary to provide safe and quality care The development of the nurse-client therapeutic relationship is dependent on effective communication. 32 References  Bergner, A. (2017). Enhancing Communication to Improve Patient Safety and to Increase Patient Satisfaction. The Healthcare Manager, 36(3), 238-243.  Brown, R., & Crookes, P. A. (2016). What are the ‘necessary’ skills for a newly graduating RN? Results of an Australian Study. BMC Nursing, 15(23), 1-8. doi:10.1186/5/2912-016-0144-8  Canadian Patient Safety Institute (2020). Glossary. https://www.patientsafetyinstitute.ca/en/toolsResources/PatientSafetyIncidentManagementToolkit/Pages/Glossary.aspx.  Daugherty, K., Derig, M. K., Dingley, C., & Persing, R. (2008). Improving Patient Safety Through Provider Communication Strategy Enhancements. In B. J. Henriksen K, Advances in Patient Safety: New Directions and Alternative approaches (Vol. 3). Rockville(MD): Agency for Healthcare Research and Quality. Retrieved from https://www.ncbi.nlm.gov/books/NBK43663  Hertel, R. (2019). Building a Healthy Practice Environment. MEDSURG Nursing, 73-74.  Kourkouta, L., & Papathanaslou, I. (2014, Feb. 26). Communication in Nursing Practice. doi:10.545/msm2014.2665-67  Mallette, C. & Yonge, O. (2022). Arnold & Boggs’s Interpersonal relationships: Professional communication skills for Canadian nurses. Elsevier.  RiskAnalyticica. (2019, July 17). Canadian Patient safety Institute. Retrieved from CPSI: http://www.patientsafetyinstitute.ca 33